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Comparison of the Clinical Characteristics and Outcomes of Klebsiella pneumoniae Meningitis and Streptococcus pneumoniae Meningitis

Session: Poster Abstract Session: CNS Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Klebsiella pneumoniae is an uncommon cause of community-acquired bacterial meningitis. The clinical and laboratory characteristics of community-acquired K. pneumoniae meningitis (CA-KPM) remain to be elucidated. In this study, we compared the clinical and laboratory features, and outcomes, of CA-KPM with those of community-acquired Streptococcus pneumoniae meningitis (CA-SPM). 

Methods: This multi-center, retrospective cohort study was performed at 8 general hospitals in the Republic of Korea. Using a clinical microbiology computerized database, all patients whose cerebrospinal fluid (CSF) cultures yielded K. pneumoniae or S. pneumoniae between January 1997 and March 2013 were identified. Adult patients with clinical meningitis were identified by detailed review of medical records. 

Results: A total of 83 patients, 27 with CA-KPM and 56 with CA-SPM, were included. The proportion of males (KPM, 55.6% vs. SPM, 55.4%, P = 0.99) and median age (KPM, 59 year vs. 59 year, P = 0.23) were not significantly different between the groups. Diabetes mellitus (KPM, 48.1% vs. SPM, 21.4%; P = 0.01) and liver cirrhosis (KPM, 22.2% vs. SPM, 5.4%; P = 0.05) were more common in the CA-KPM group. Although the profiles of CSF analyses did not differ significantly between the groups, comatose mentality was more frequent in the CA-KPM group (KPM, 40.7% vs. SPM, 12.5%; P = 0.01). Septic shock (KPM, 44.4% vs. SPM, 89%; P < 0.001) and concomitant extrameningeal infection were also more common in the CA-KPM group (KPM, 37% vs. SPM, 7.1%; P = 0.001). Vancomycin plus cefotaxime/ceftriaxone was the most frequently used initial empirical therapy (KPM, 74.1% vs. SPM, 85.7%; P = 0.23) in both groups. However, 28-day mortality (KPM, 44.4% vs. SPM, 10.7%; < 0.001) and in-hospital mortality (KPM, 51.9% vs. SPM, 14.3%; P < 0.001) were higher in the CA-KPM group.

Conclusion: Diabetes mellitus and liver cirrhosis are more common in K. pneumoniae meningitis than S. pneumoniae meningitis, and the former is more likely to present severe manifestations and poor outcomes.

Jiwon Jung, MD1, Shinae Yu, MD1, Sun In Hong, MD1, Ju Young Lee, MD1, Ki-Ho Park, MD2, Seong Yeon Park, MD3, Eun Hee Song, MD4, Eun Jung Lee, MD5, Seong-Ho Choi, MD6, Eun Ju Choo7, Yee Gyung Kwak, MD8, Sung-Han Kim, MD1, Sang-Oh Lee, MD1, Yang Soo Kim, MD1, Jun Hee Woo, MD1 and Sang-Ho Choi, MD1, (1)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (2)Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, South Korea, (3)Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea, (4)Department of Infectious Diseases, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea, (5)Infectious Diseases, Soonchunhyang University Hospital, Seoul, South Korea, (6)Chung-Ang University Hospital, Seoul, South Korea, (7)Division of Infectious Diseases, Soonchunhyang University Hospital, Bucheon, South Korea, (8)Inje University, Goyang, South Korea


J. Jung, None

S. Yu, None

S. I. Hong, None

J. Y. Lee, None

K. H. Park, None

S. Y. Park, None

E. H. Song, None

E. J. Lee, None

S. H. Choi, None

E. J. Choo, None

Y. G. Kwak, None

S. H. Kim, None

S. O. Lee, None

Y. S. Kim, None

J. H. Woo, None

S. H. Choi, None

See more of: CNS Infections
See more of: Poster Abstract Session

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